Bunik Maya, Galloway Kelly, Maughlin Mike, Hyman Daniel
Department of Pediatrics, University of Colorado Anschutz Medical Campus.
Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus.
Pediatr Qual Saf. 2021 Dec 15;6(6):e484. doi: 10.1097/pq9.0000000000000484. eCollection 2021 Nov-Dec.
The American Academy of Pediatrics Bright Futures recommends routine well-child care as optimal care for children. This quality improvement project aimed to increase adherence to the "First Five" visits after newborn follow-up at 2, 4, 6, 9, and 12 months-by 25% (50% or higher) and continuity with providers by 20% (64% or higher) between 2013 and 2016.
Retrospective data collection identified a quality gap, in which only 25% had the required well-child visits by the first year. We interviewed parents/caregivers of 12- to 15-month-old children for their perspectives on access to care, scheduling, and the medical home concept. Plan-Do-Study-Act cycles targeted modification of electronic medical record templates, scheduling, staff and parental education, standardization of work processes, and birth to 1-year age-specific incentives. We then piloted interventions in one of our clinic's pod/subgroup. Process and outcome measures were analyzed using descriptive statistics, a run chart, and a 2-sample % Defective Test.
Parent/caregiver interviews revealed that only 6% knew what a medical home was, and only 40% "almost always saw the same provider for care." At baseline in 2012, we documented completion of all 5 visits in only 25% of the children; <10% of those children had consecutive visits with the same provider. After multiple Plan-Do-Study-Act cycles and pilot, our "First Five" well-child care adherence rose to 78%, and continuity increased to 74% in 2018 ( < 0.001 for adherence, < 0.001 for continuity).
A multifaceted, evidence-based approach improved both well-child care adherence and provider continuity.
美国儿科学会的“光明未来”计划推荐定期的儿童健康检查作为儿童的最佳护理方式。这个质量改进项目旨在提高2013年至2016年间新生儿在2、4、6、9和12个月进行随访后的“前五次”就诊依从率（提高25%，即达到50%或更高），并将与医护人员的连续性提高20%（达到64%或更高）。
通过回顾性数据收集发现了一个质量差距，即只有25%的儿童在一岁前完成了所需的儿童健康检查。我们采访了12至15个月大儿童的父母/照顾者，了解他们对获得医疗服务、预约安排和医疗之家概念的看法。计划-执行-研究-行动循环针对电子病历模板的修改、预约安排、员工和家长教育、工作流程标准化以及针对出生至1岁儿童的激励措施。然后我们在诊所的一个单元/子组中试点干预措施。使用描述性统计、运行图和双样本缺陷率检验对过程和结果指标进行分析。
对父母/照顾者的访谈显示，只有6%的人知道医疗之家是什么，只有40%的人“几乎总是看同一位医护人员进行护理”。在2012年基线时，我们记录到只有25%的儿童完成了所有五次就诊；这些儿童中不到10%连续看同一位医护人员。经过多次计划-执行-研究-行动循环和试点，我们的“前五次”儿童健康检查依从率在2018年升至78%，连续性提高到74%（依从率p<0.001，连续性p<0.001）。
多方面、基于证据的方法提高了儿童健康检查的依从率和医护人员的连续性。
